ELEMENTOS BÁSICOS DE LA PLANIFICACIÓN DIDÁCTICA

The findings of this study exemplify the level of dominance of the state over professions. This dominance has been explored by a number of authors: Fielding and Portwood (1980); Gieson (1984); Cocks and Jarauch (1990); Macdonald (1995). The dominance of the state is fostered by the weakness of the organised profession and as such growth trajectories are dependent on the state policy. As already demonstrated in 5.1.1 above, state control set the pace for educational advancement which was based solely on sporadically identified needs of what role nurses should play

at each point in the healthcare system. Forty years after independence the government of Cameroon decided to liberalize the higher education sector and nurse education was swept into this new reforms. The political context at the time of liberalization has to be explained.

In an analysis of multi-party politics in Cameroon, Awung and Atanga (2011) describe the political evolution from the Ahidjo to the Biya government (current government). According to them, by 1972 Ahidjo had dissolved the federal state structure and the new constitution made him the sole repository of state authority. Therefore the professional project for nursing was further hampered because in such a context the state cannot allow the development of a strong autonomous professional group. They go on to report that the Biya government came to power in November 1982 with promises of liberalization, press freedom, opening of the political system and fighting corruption. After surviving a coup d’etat in 1984 the new government asserted control over all state affairs thus perpetuating the authoritarian patrimonial state that was shaped by hegemonic alliances from various ethno-regional groups with the sole goal of maintaining the hold on power (Awung and Atanga, 2011). From the political stand point the change in government did not change the state’s approach to power and civil society interaction. The centre of power remained with the authorities implying that professions in the country will have a difficult task to establish their autonomy and control their education. For nursing, the political system perpetuated the closed loop between multiple births and formation and continuing reactive growth. The political system did not favour any break from this closed loop and the profession had no role in determining future education trends. From the work of Konnings (2011) a combination of factors including the economic crisis, the reintroduction of multiparty politics, civil disobedience and the role of the Bretton Woods institutions will cause the government to introduce economic and political reforms in the decades of the 90s. As a condition for helping the government with funding the Bretton Woods institutions insisted on “reduction of public expenditure, removal of public subsidies, dismantling of the public sector, privatisation and promotion of private enterprise, trade liberalization, producer price reforms, currency devaluation, restructuring of state institutions and legal reforms aimed at supplying an enabling environment” (Konnings, 2011). Awung and Atanga (2011) argued that the government

failed to fully cooperate with the Bretton woods institutions on these reforms. However, Konnings (2011) observed that in spite of this quite some progress has been made even after initial government resistance including in the areas of liberalization. This was thus the socio-political context at the time when key government policy issues like the suspension of training of nurses and the liberalization of higher education respectively directly and indirectly affected nurse education.

Policies like liberalization are taken by the state based on its agenda at a particular time. As revealed in the study the nature of liberalization is the opening of the educational sector to civil society. Individuals and organisations have the opportunity to participate in the delivery of education under frameworks established by the state. Liberalization of higher education in Cameroon led to two significant impacts on nurse education: nurse education started in private higher institutes and a number of universities (both private and state-owned) and for the first time education programmes led to award of degrees; and the role of non-nurses (who now came in as entrepreneurs) in nurse education was strengthened. Critics of liberalization see it as commercialising nurse education because entrepreneurs have invested in the running of nurse education programmes. This commercialisation or marketisation is perceived to override the desire for high standards of teaching as economic concerns trump quality and professional values. Anxieties of professionals relate to apparent loss of control over student selection, educational structure and content, and proliferation of nurse education institutions. For a state controlled profession however, this education control had never been in the hands of the profession in the first place. Tight control by the state creates a sense of order that is lost in the liberalization environment which appears market-driven.

Marketisation has become a reality that academics have to live with it (Furedi, 2011). It often refers to the creation of “quasi-markets” in state funded and/or state provided services (Whitty and Power 2000) and is characterised by a separation of the provider from the purchaser with the introduction of choice between providers with state regulation especially in areas of investment, quality, entry of new providers, and price which is often free to the user (Levaçic, 1995: 167). It creates a sense of education as a commodity which is being sold by the institution to the student customer. This perception is one of the main criticisms of marketization as Furedi (2011:3) sadly notes that many

universities have adopted the student as customer model. Drawing from the philosopher Socrates, Mills (1978) observed that in a context like marketization teachers do not necessarily strive to make students acquire knowledge but rather pander to their desires encouraging them to be even more pleased with vices and errors. Furedi (2011:4) adds that the present ‘worship’ of student satisfaction in universities has fostered an environment where institutions are so interested in pleasing student customers and avoiding complains for fear of litigation. Furedi (2010) seems to agree with Mill (1978) that intellectual development is compromised in students when they start perceiving themselves as customers. This is exacerbated by the fact that due to commercial pressures institutions might become more interested in securing more customers than focusing on the educational needs of the students (Furedi, 2011: 5; Mill, 1978). So while it might be argued that liberalization of education which usually goes with privatisation, will help to increase access to education and capacity building for the work force, Gregoruti et al (2016) studying the process in Latin America observed that institutions took advantage of loop holes in the law in the absence of strict regulations and that quality was a central concern and some of the mechanisms implemented to deal with it were effective. They added that even though enrolment had gone up, there were several mismatches that challenge the whole goal of the policy to increase human capacity for economic development.

The above paragraph presents strong views against marketization that emerge in a context of liberalization and match anxieties in the findings of the study. At the same time it can be forcefully argued that opening up higher education brings in qualitative improvements derived from competition. Training is no longer designed only to meet the needs of the Ministry of Health but is now directed at improved professional competencies that create better conditions for the redefinition of professional identity. In the liberalised setting professionals can now choose from the variety of academic institutions and programmes according to their needs and professional goals. Professionals who want to acquire education for international roles can make that decision. Those who want to specialise in a particular area can have access to that education even if it were not a prioritised area for government practice. Institutions have greater autonomy which makes them more responsive to the demands of students and stakeholders as well as changing international trends in education. The

state continues to play a role in regulating the creation and regulation of institutions and sets guidelines required for institutions to maintain their license. This helps to hold certain excesses in check and allow professions to take advantage of a freer system to influence education policies in their sector. These arguments echo the findings from the study reflecting the positive impact of liberalization. Brown (2011) proposes four characteristics of the marketised higher education system i.e. institutional autonomy, competition, price and information. He argued that aspects like regulated ease of market entry, genuine possibilities of student choice, linking of institutional funding to enrolment which encourages student recruitment and absence of externally imposed limits to student intake are conditions that when combined with price options create genuine competition among education institutions. The ability of the government to provide information on accredited institutions and for the institutions to provide information on what they offer increase diversity and choice for students and sponsors. Though it might sound like the buying and selling of education where the institution is selling and the student is buying, marketization according Furedi (2011) is more about having a highly controlled quasi-market that forces academic institutions to compete against each other for resources and funding.

As already observed liberalisation was not about nurse education but created a new dimension of national education that affected nursing. This shows how vulnerable professions could be to changes within their socio-cultural environment that did not necessarily target them. The impact of such changes could affect the professions positively or negatively. As discussed above liberalization has led to marketization of education including nurse education. At the same as the study results show, liberalization brought an expansion of nurse education and increased education access for practising nurses and for people seeking a career in nursing. Access is increased by the creation of many new institutions which come with a variety of programmes. In the research context, many nurses have already benefited from this expansion by obtaining higher qualifications which were hitherto unavailable. Higher qualifications are generally associated with higher salaries and better recognition in the work setting. This positive impact at the level of individuals creates a group that will be pro- consolidation of the gains of liberalization. Expansion of education also means more employment

opportunities for nurses who become teachers in new nursing schools on full time or part time basis. More income will likely translate to better living conditions and strengthen the social status of the profession. In a study of the implications of education on social mobility Lindley and Machin (2012) found that individuals with more education earned better wages and that even with increasing number of highly educated individuals, organisations demand for highly educated employees did not fall. However, they also argued that the trends inhibit social mobility because mostly the financially comfortable have benefitted from education expansion therefore increasing already existing income inequality. The subtle argument here is education is leading to greater upward social mobility but at the same consolidating class inequality. Nursing has been associated with gender and social class narratives.

Other authors have discussed nursing’s evolution from the perspective of nursing as a ‘helping female vocation and a middle-class occupation’ (Callinicos, 1983; Erickson and Goldthope, 1992; Weston, 2011; Ayala et al, 2014). In this context social mobility in nursing was strongly related to women leaving their domestic roles to a respectable role out of the home. In a country like Chile, Ayala et al (2014) observed that the nursing profession began among the ‘female elite’ class with well educated women who moved into the nursing occupation from volunteering roles. The entry of Chilean nurse education therefore became a case of upward social mobility for women as it was of the profession. In other contexts, racism emerges as another factor in addition to class and gender influencing social mobility of nursing. D’Antonio (2004) highlighted the race issue by citing Burgess (1982) that the insatiable demand for nurses at the time led to training schools admitting just anybody with varying social and educational backgrounds. She advanced her argument by pointing out that general population numbers used to compare women in nursing to the general population ignored the fact that the numbers included “natives and immigrants, whites and blacks, reds and yellows of all kinds of social conditions”. In analysing Burgess, D’Antonio (2004) argued that her position meant that women of other backgrounds were not a suitable benchmark for the widely held view at the time that nursing should be dominated by white middle-class women. So race and social background were

aspects that defined the profession and influenced social mobility. The entry of people of colour and poor social backgrounds into nursing was considered and upward mobility for these groups.

The race, gender, or class perspective of upward social mobility for nurses differs from the trend emerging from the current study. The expansion of education opportunities is more linked with a higher social status of the profession when compared to others like medicine and an enhanced self- confidence in nurses themselves. Gender arguments cannot be made because there are an almost balanced number of female and male nurses in Cameroon. Racial discriminations have not been empirically found or reported in Cameroonian society. Rather expansion from liberalization brought nurses more respect from the society because nurses could now be educated at higher academic levels than what the system had been typically accustomed to since independence. The expression of appreciation and the attempts made by nurses to take credit for education expansion as revealed in the study findings indicate a generally positive reception of the current changes. Nurses are proud to associate their education with higher education even as liberalization breeds policy controversies in the nurse education process. However, there is little evidence from documents studied to support the arguments put forward by some nurses that expansion was a result of organised nursing’s effort. Extant literature on the political situation in Cameroon at the time showed that government was responding to internal and external pressures (political and economic) that had nothing to do with nurse education. From this angle, the reactive and erratic growth paradigm is reinforced. It also implies that the liberalization process is completely out of the control of nursing and since its future direction cannot be determined the profession still cannot predict its continuous impact on nurse education.

In summary, the argument in this section then is that in a situation where there exists: multiple births and formation; domination by a strong centralised state; and absence of viable professional association, professional education is completely out of the hands of the profession. The profession is created by the state for its needs and makes any changes to the education system according to changing needs. There is no regulatory bargain between the state and the profession and the status of the occupational group as a profession is not recognised. In such a scenario growth is erratic and

reactive to government’s whims. When national agenda in such countries suddenly tilt towards liberalization there opens another chapter of reactive growth as a result of increase access and opportunities for education. Liberalization policies when applied generally do not target a profession and its needs so educational changes are bound to raise anxieties and present real or apparent threats to long held standards and views of what education should look like. The tendency then to see liberalization effect on professional education is present but the advantages it provides once understood by members of the profession can serve as a unique opportunity for change. The opportunity emerges from the fact that government is letting go of its tight control and therefore definition of the identity of the profession. Liberalization especially of education therefore presents a unique opportunity for professions to seize the narrative of their education and redefine their identity and role within the country.